Effects of Epicardial Fat Reduction on P-wave Duration of Morbidly Obese Patients Submitted to Bariatric Surgery

An Observational Study

Authors

  • Acácio Fernandes-Cardoso
  • Meive Santos-Furtado
  • José Grindler
  • Alfredo José Fonseca
  • Carlos Rodrigues Oliveira
  • Nemer Luiz Pichara
  • Roberto Cleva
  • Marco Aurélio Santo

Keywords:

P Wave, Morbid Obesity, Bariatric Surgery

Abstract

Introduction: Epicardial fat (EF) is biologically active and, through its paracrine effect, interacts with the atrial myocardium and may be involved in the atrial remodeling observed in obese individuals. P-wave duration (PWD) is a non-invasive marker of atrial conduction time and reflects changes related to atrial remodeling. The effects of the reduction of EF induced by bariatric surgery on PWD have not yet been defined. Methods: We prospectively recruited 22 morbidly obese patients with no other comorbidities at the Unidade de Cirurgia Bariátrica (Bariatric Surgery Unit) of Universidade de São Paulo’s Hospital das Clínicas. The patients were submitted to clinical and laboratorial evaluations, 12-lead eletrocardiography (ECG), two-dimensional echocardiogram and 24 h Holter. The same evaluation was performed 12 months after bariatric surgery. In order to make a comparison of the continuous variables, we used the paired and Wilcoxon T tests. To evaluate the association between independent variables, a regression model was used for repeated measures. Results: A total of 20 patients completed the protocol (age: 36.35 ± 10.26 years, 18 women). There was a significant reduction of PWD, body mass index (BMI) and EF after bariatric surgery (p<0.05). There was also an average reduction of 11.55 ± 8.49 ms in PWD. In the multiple regression analysis, an association was observed between the reduction of PWD and the reduction of EF and BMI. Conclusions: In morbidly obese patients with no other comorbidities, the reduction of EF after bariatric surgery was associated with an improvement in atrial remodeling indicated by a significant reduction in PWD.

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References

Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, biomolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med 2005 Oct;2(10):536-43. https://doi.org/10.1038/ncpcardio0319

Corradi D, Maestri R, Callegari S, Pastori P, Goldoni M, Luong TV, et al. The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol 2004 Nov;13(6):313-6. https://doi.org/10.1016/j.carpath.2004.08.005

Sacks HS, Fain JN. Human epicardial fat: what is new and what is missing? Clin Exp Pharmacol Physiol 2011 Dec 1;38(12):879-87. https://doi.org/10.1111/j.1440-1681.2011.05601.x

Cikim AS, Topal E, Harputluoglu M, Keskin L, Zengin Z, Cikim K, et al. Epicardial adipose tissue, hepatic steatosis and obesity. J Endocrinol Invest. Springer International Publishing 2007 Jun;30(6):459-64. https://doi.org/10.1007/BF03346328

Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology 2003 Jun;144(6):2195-200. https://doi.org/10.1210/en.2003-0285

Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005 Apr;365(9468):1415-28. https://doi.org/10.1016/S0140-6736(05)66378-7

Bos D, Vernooij MW, Shahzad R, Kavousi M, Hofman A, van Walsum T, et al. Epicardial fat volume and the risk of atrial fibrillation in the general population free of cardiovascular disease. JACC Cardiovasc Imaging 2017 Nov;10(11):1405-7. https://doi.org/10.1016/j.jcmg.2016.12.005

Auer J. Fat: an emerging player in the field of atrial fibrillation. European heart journal 2017;38:62-5. https://doi.org/10.1093/eurheartj/ehw013

Hari KJ, Nguyen TP, Soliman EZ. Relationship between P-wave duration and risk of atrial fibrillation. Expert Rev Cardiovasc Ther2018 Nov;16(11):837-43. https://doi.org/10.1080/14779072.2018.1533814

Fernandes-Cardoso A, Santos-Furtado M, Grindler J, Ferreira LA, Andrade JL, Santo MA. Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity. Nutr Metab Cardiovasc Dis 2017 Aug;27(8):731-8. https://doi.org/10.1016/j.numecd.2017.05.009

Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr 2009 Dec;22(12):1311-9;1417-8. https://doi.org/10.1016/j.echo.2009.10.013

Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P Wave duration and dispersion in obese subjects. Ann Noninvas Electro 2008 Jan 1;13(1):3-7. https://doi.org/10.1111/j.1542-474X.2007.00194.x

Abed HS, Samuel CS, Lau DH, Kelly DJ, Royce SG, Alasady M, et al. Obesity results in progressive atrial structural and electrical remodeling: implications for atrial fibrillation. Heart Rhythm 2013 Jan;10(1):90-100. https://doi.org/10.1016/j.hrthm.2012.08.043

Lin YK, Chen YC, Chen JH, Chen SA, Chen YJ. Adipocytes modulate the electrophysiology of atrial myocytes: implications in obesity-induced atrial fibrillation. Basic Res Cardiol2012 Sep;107(5):293. https://doi.org/10.1007/s00395-012-0293-1

Mahajan R, Lau DH, Brooks AG, Shipp NJ, Manavis J, Wood JPM, et al. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol 2015 Jul 7;66(1):1-11. https://doi.org/10.1016/j.jacc.2015.04.058

Friedman DJ, Wang N, Meigs JB, Hoffmann U, Massaro JM, Fox CS, et al. Pericardial fat is associated with atrial conduction: the Framingham Heart Study. J. Am. Heart Assoc 2014 Apr 22;3(2):e000477-7. https://doi.org/10.1161/JAHA.113.000477

Iacobellis G, Leonetti F, Singh N, Sharma AM. Relationship of epicardial adipose tissue with atrial dimensions and diastolic function in morbidly obese subjects. Int J Cardiol 2007. Feb;115(2):272-3. https://doi.org/10.1016/j.ijcard.2006.04.016

Jhuo SJ, Hsieh TJ, Tang WH, Tsai WC, Lee KT, Yen HW, et al. The association of the amount of epicardial fat, P wave duration, and PR interval in electrocardiogram. J Electrocardiol 2018 Jul-Aug;51(4):645-51. https://doi.org/10.1016/j.jelectrocard.2018.04.009

Tuluce K, Kara C, Tuluce SY, Cetin N, Topaloglu C, Bozkaya YT, et al. Early reverse cardiac remodeling effect of laparoscopic sleeve gastrectomy. Obes Surg 2017 Feb;27(2):364-75. https://doi.org/10.1007/s11695-016-2301-2

Falchi AG, Grecchi I, Muggia C, Tinelli C. Weight loss and P wave dispersion: a preliminary study. Obes Res Clin Pract 2014 Nov-Dec;8(6):e614-7. https://doi.org/10.1016/j.orcp.2014.08.005

Monno K, Okumura Y, Saito Y, Aizawa Y, Nagashima K, Arai M, et al. Effect of epicardial fat and metabolic syndrome on reverse atrial remodeling after ablation for atrial fibrillation. J Arrhythm 2018 Oct 13;34(6):607-16. https://doi.org/10.1002/joa3.12124

Mahajan R, Nelson A, Pathak RK, Middeldorp ME, Wong CX, Twomey DJ, et al. Electroanatomical remodeling of the atria in obesity: impact of adjacent epicardial fat. JACC Clin Electrophisiol 2018 Dec;4(12):1529-40. https://doi.org/10.1016/j.jacep.2018.08.014

Dilaveris P, Batchvarov V, Gialafos J, Malik M. Comparison of different methods for manual P wave duration measurement in 12-lead electrocardiograms. Pacing Clin Electrophysiol 1999 Oct;22(10):1532-8. https://doi.org/10.1111/j.1540-8159.1999.tb00358.x

Published

2019-10-17

How to Cite

Fernandes-Cardoso, A. ., Santos-Furtado, M. ., Grindler, J. ., Fonseca, A. J. ., Oliveira, C. R. ., Pichara, N. L., Cleva, R. ., & Santo, M. A. . (2019). Effects of Epicardial Fat Reduction on P-wave Duration of Morbidly Obese Patients Submitted to Bariatric Surgery: An Observational Study. JOURNAL OF CARDIAC ARRHYTHMIAS, 32(2), 82–88. Retrieved from https://jca.emnuvens.com.br/jca/article/view/25

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Section

Clinical Arrythmia

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